Which Medicines Lower “Bad” (LDL) Cholesterol?

When you have high cholesterol, the first thing to do is to change your diet and fitness: less saturated fat, no trans fat, and more activity.

If that doesn’t bring down your “bad” (LDL) cholesterol enough, your doctor may suggest that you also take medicine to help out. (You’ll still need to keep up those lifestyle habits.)

There are several different types of prescription drugs that lower LDL. Get to know what each of them does.

The Most Common Cholesterol Meds: Statins

These are usually the first type of drug that doctors prescribe to lower LDL. They also lower triglycerides, which are another type of blood fat, and mildly raise your "good" (HDL) cholesterol.

Statins include:

  • Atorvastatin (Lipitor)
  • Fluvastatin (Lescol)
  • Lovastatin
  • Pitavastatin (Livalo)
  • Pravastatin (Pravachol)
  • Rosuvastatin (Crestor)
  • Simvastatin (Zocor)

Studies show that statins lower the chance of a “cardiovascular event” such as a heart attack.

Side effects can include intestinal problems, liver damage (rare), and muscle inflammation. High blood sugar and type 2 diabetes may also be more likely with statins, although the risk is “small” and the benefits outweigh the risks, according to the FDA.

Statins drugs may also interact with other medications you take. Your doctor should check on that first.

Some people who take statins have reported memory loss and confusion. The FDA is looking into those reports and notes that in general, the symptoms weren’t serious and were gone within a few weeks after the person stopped taking the drug.

You should avoid grapefruit and grapefruit juice when you take statins. Grapefruit makes it harder for your body to use these medicines.

Niacin

What it is: This B-vitamin, also known as nicotinic acid, is found in food but is also available at high doses by prescription. It lowers LDL cholesterol and raises HDL cholesterol.

Examples include: 

  • Niaspan
  • Nicoar

Research has not shown that adding niacin, when you already take a statin, further lowers your risk of heart disease.

Side effects: The main ones are flushing, itching, tingling, and headache.

Drugs that Work in Your Intestine

What they are: Your doctor may call these “bile acid resin” drugs or “bile acid sequestrants.” The work inside your intestine. They attach to bile from the liver and prevent it from being absorbed back into your blood. Bile is made largely from cholesterol, so these drugs whittle down the body's supply of cholesterol.

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Examples include:

  • Colestipol (Colestid)
  • Cholestyramine (Prevalite)
  • Colesevelam (WelChol)

A different type of drug, ezetimibe (Zetia), lowers bad LDL cholesterol by blocking cholesterol absorption in your small intestine. Studies have found that in people who have already had a heart attack, it can make a small cut in the risk of heart “events,” such as another heart attack, when you also take a statin.

Side effects: For bile acid drugs, the most common side effects are constipation, gas, and upset stomach. For ezetimibe, the most common ones include muscle or back pain, diarrhea, and abdominal pain.

Targeting Triglycerides: Fibrates

“Fibrates” are drugs that cut down on how much triglycerides your body makes and can also boost your “good” HDL cholesterol.

Examples include:

  • Fenofibrate
  • Gemfibrozil (Lopid)

The Newest Type of Drug: PCSK9 Inhibitors

What they are: These drugs are used in people who can’t manage their cholesterol through lifestyle and statin treatments. They block a protein called PCSK9 to make it easier for the body to remove LDL from your blood.

They are mainly used in adults who inherit a genetic condition called “heterozygous familial hypercholesterolemia” that makes it hard to bring down their cholesterol level, or for people who had heart disease and need more than a statin. You get them as a shot every 2 weeks.

Examples:

  • Alirocumab (Praluent)
  • Evolocumab (Repatha)

Side effects: Because these drugs are newer, it will take more time to get to know their side effects. In clinical trials, the most common ones for alirocumab are itching, swelling, pain, or bruising where you get the shot, as well as colds and flu. For evolucumab, they include colds, flu, back pain, and skin reactions where you get the shot.

WebMD Medical Reference Reviewed by James Beckerman, MD, FACC on March 22, 2016

Sources

SOURCES:

American Heart Association.

FDA: “FDA Expands Advice on Statins Risk,” “Zetia (ezetimibe) Tablets.”

UptoDate: “Patient Information: High cholesterol treatment options (Beyond the Basics).”

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